Vaginal Stump Metastasis from Sigmoid Colon Cancer

Abstract

Background: Vaginal metastasis from organs other than the uterus is rare. Generally, patients with vaginal metastasis from colorectal cancer have a dismal prognosis. Although biopsy is the best method to make the diagnosis, massive bleeding may occur. On the other hand, liquid-based cytology (LBC) has the utility to perform immunocytochemistry on additional unstained slides: we can make a diagnosis with several immunocytochemical findings. Case: A 67-year-old postmenopausal female presented to our hospital with vaginal bleeding. The patient had undergone colectomy because of her stage III sigmoid colon cancer 3 years earlier. The patient had also undergone hysterectomy for cervical cancer 30 years earlier. LBC from the vaginal stump revealed adenocarcinoma. Immunocytochemically, cancer cells were negative for cytokeratin 7 and positive for cytokeratin 20, which suggested metastasis from the sigmoid colon cancer; the diagnosis was made without a biopsy. Conclusion: When the patient has a metastatic lesion from colon adenocarcinoma, LBC with immunocytochemistry is useful in making a diagnosis.

Metastatic colorectal adenocarcinoma in cervicovaginal cytology specimens confirmed by immunocytochemical stains on liquid base specimens: Two study cases with review of the literature

“…[4] We agree with their opinion that in metastatic cancers to the cervicovaginal region with characteristic ICC findings such as colorectal carcinoma, biopsy may not be needed for confirming the diagnosis as it may be associated with excessive bleeding. [4] However, a more inclusive panel of immunohistochemical markers including CK7, CK20, and CDX2 showing characteristic CK7−/CK20+/CDX2+ pattern of immunohistochemical expression is needed for confirmation.…”

“…Other sites include breast, gastrointestinal tract, and rarely other sites. [234] Recognition of the extra-uterine malignancy in the cervicovaginal cytology specimen is critical for the disease diagnosis, prognosis, and treatment. Abnormal findings on the routine gynecological clinical examination can be the first step to lead to the discovery of a metastatic lesion.…”

“…[23] These patients carry a dismal prognosis. [4] The routine gynecological clinical examination can be the first step in identifying the metastatic malignancy. Both conventional and liquid based cytology (LBC) have limited sensitivity and specificity in diagnosing metastatic disease.…”

MRI findings of a remote and isolated vaginal metastasis revealing an adenocarcinoma of the mid-sigmoid colon

“…To the best of our knowledge, only 20 cases have been described in the literature (pubmed search criteria: colon, sigmoid, cancer, adenocarcinoma, vagina, metastasis, metastases): the vaginal symptoms were the first clinical mark in ten cases [1,5,6], while the vaginal involvement was subsequent to the discovery of the colonic cancer, often years after surgery, in the others [2,4,7]. Moreover the majority of these cases presented other metastatic locations, while only three patients showed exclusively a remote isolated vaginal metastasis [2,5,6].…”

Current approach to metastasis of extra-genital system malignancies to the female genital tract

“…Kolorektal adenokarsinomun karekteristik immünohistokimyasal bulguları negatif sitokeratin 7 (CK7) ve pozitif sitokeratin 20 (CK20) boyamasıdır. Çalışmalarda metastazdan alınan sitoloji örneğinde CK7 negatif, ve CK20 pozitif olduğu durumlarda primer kanserin, kolorektal kanser olma olasılığı %75-95 kadar olduğu görülmüştür [15]. İzole vajen metastazı olgularında tedavi yaklaşımı kama rezeksiyon ve RT'dir [16].…”